一位腎細胞癌合併骨轉移患者之居家護理經驗

Home Care Experience of a Renal Cell Carcinoma Patient with Bone Metastasis

本文主要探討一位64歲罹患腎細胞癌合併骨轉移的個案，出院返家照護的居家護理經驗，筆者以Orem自我照護理論進行評估，並應用居家訪視、電訪關懷、醫師家訪等方式收集資料，發現個案有疼痛、皮膚完整性受損及無力感等健康問題。居家照護期間為2009年04月03日至2009年05月22日共訪視4次、電訪8次，透過居家護理師以個案為中心，鼓勵個案說出感受、提供家屬和個案疼痛相關資料及用藥衛教、非藥物的疼痛控制技巧、指導翻身技巧及輔助方法、相關護理技能指導及回覆示範，有效的降低個案疼痛的感受與不適，於疼痛控制下ADL由0分增加到15分，增加自我照顧能力、減少個案無力感，進而提昇自我價值。

The report described the experiences of home nursing care for a 64-year-old patient with renal cell carcinoma with bone metastasis. The Orem theory of self-care was used to assess the patient’s self-care ability. Records of home visits, telephone interviews, and physician home visits were analyzed. The patient was found to have pain, impaired skin integrity, and powerlessness. Four home visits and eight telephone interviews were completed between April 3, 2009 and May 22, 2009. The home-care nurse encouraged the patient express feelings and provided pain-related information to the patient and his families. Education regarding medication use, non-medication pain control techniques, and trunk-rolling skills were also provided. With the instruction and demonstration, the patient’s feeling of pain was effectively reduced. The activities daily living score also increased from 0 to 15. An increase of self-care ability and a decrease of powerlessness feelings were achieved. Patients’ self-esteem was also improved.